tbuckley/cabot-search huggingface dataset:
Abstract 12170: A National Heart Failure Initiative is Associated With Improved Use of Guideline-Directed Medical Therapies
Authors: Sruthi Cherkur, Robin Y Kiser, Lynn Serdynski, Rhoda Saunders, Christina Sterzing, Kelly L Macheska, Michelle C Scharnott, Michele M Bolles, Georges Chahoud, Kanika Mody, MITCHELL SALTZBERG, Andrew J Sauer, Steven Spencer, John A Spertus, joyce Wald, Gregg C Fonarow, Clyde W Yancy
Journal: Circulation (2022)

Background: Heart Failure (HF) is projected to impact over 8 million people by 2030. Guideline-Directed Medical Therapy (GDMT) reduces mortality and morbidity, but many eligible patients are not receiving the recommended medications. The 2022 ACC/AHA/HFSA Guideline for the Management of HF highlight the importance of SGLT2i and ARNi, which continue to be underused in eligible HFrEF patients. Methods: IMPLEMENT-HF (I-HF), a national HF quality improvement initiative focusing on early adoption of GDMT, aims to improve use of SGLT2i and ARNi for HFrEF patients. I-HF creates a transformative learning collaborative and resource repository across seven U.S regions to promote education and adherence to GDMT, that includes sharing models of clinical care, targeted training, resource development, and quality improvement consultation. Participation in a learning collaborative allows for sharing of interventions, such as adding SGLT2i on formulary, optimizing EHR tools for GDMT (best practice alerts, disease-specific order sets, dot phrases), provider education, and patient resources to address medication affordability. Sites receive educational materials, including webinars, pocket guideline booklets, and guideline reminder cards to reinforce GDMT. Participating hospitals collect GDMT data in Get With The Guidelines®-Heart Failure (GWTG-HF). ARNi and SGLT2i at discharge was analyzed from baseline (Q1 &amp; Q2 2021 aggregate) through Q1 2022. Results: Data from 62 sites (16,533 HF patient records) showed that use of ARNi at hospital discharge increased from baseline 46% to 58% in Q1 2022, +12%, p value &lt;0.001. SGLT2i use at discharge increased from 8% to 26%, +18%, p value &lt;0.001 (Figure 1). Conclusions: Among centers participating in the I-HF initiative, early findings suggest there has been a rapid increase in use of SGLT2i and ARNi at discharge for HFrEF patients. Further study is needed to assess post-discharge GDMT use, adherence, and clinical outcomes.
Abstract 12277: Impact of Telemedicine New Patient Visits on Total Visit Utilization at an Academic Cardiovascular Center: An Instrumental Variable Analysis
Authors: Neil M Kalwani, Harrison Koos, Anica Oesterle, Emily V Kohn, Vijaya Parameswaran, Lubna Qureshi, Rajesh Dash, David Scheinker, Fatima Rodriguez
Journal: Circulation (2022)

Introduction: Telemedicine use has increased, but little is known about the impact of telemedicine on downstream healthcare utilization. We sought to determine the effect of conducting new patient visits (NPVs) through telemedicine on the number of follow-up visits for common cardiovascular conditions. Methods: We extracted data for all visits at an academic cardiovascular center from Jan 2019 to Feb 2022. We evaluated the effect of telemedicine vs in-person NPVs on total follow-up visits within 6 months for patients seen for 8 common primary diagnoses between Jun 2020 and Aug 2021. We utilized variation in the rate of telemedicine use among clinicians as an instrumental variable, adjusting for patient characteristics, diagnosis, subspecialty, and site. We used two-stage least squares (2SLS) and instrumental causal forest (ICF) models. Results: There were 4,856 NPVs and 3,594 follow-up visits. NPVs were delivered by 120 clinicians with 58.8% provided by telemedicine (range 0-100% across clinicians). There was no association between the average number of follow-up visits before Mar 2020 and subsequent clinician telemedicine adoption. In 2SLS analysis, there was no significant overall effect of delivering NPVs through telemedicine on the number of follow-up visits within 6 months (-0.029 visits per patient, 95% CI -0.15, 0.089). The ICF analysis similarly showed no significant overall effect of telemedicine NPVs on the number of follow-up visits. In 2SLS subgroup analyses, the effect of telemedicine NPVs differed across diagnoses (Figure). Conclusions: At an academic cardiovascular center, use of telemedicine NPVs for several common diagnoses did not affect the total number of follow-up visits within 6 months. Telemedicine NPVs can successfully replace in-person visits though their impact on total visits may differ across cardiovascular conditions. Future research should evaluate the effect of visit modality on other domains of care utilization and outcomes.
Abstract 12180: Post-Implant Beta Blocker Use and Late Right Heart Failure After LVAD Implantation: An STS-INTERMACS Analysis
Authors: Patrick M Hyland, kevin kennedy, Roy Sriwattanakomen, Marwa Sabe, Jennifer E Ho, Pablo A Quintero, lisa fleming, Shweta R Motiwala, Michael S Kiernan, Arthur Reshad Garan, E. Wilson Grandin
Journal: Circulation (2022)

Introduction: Late right heart failure (LRHF) after left ventricular assist device (LVAD) implant is associated with increased morbidity and mortality. Whether post-implant beta-blocker (BB) use can mitigate the incidence of LRHF is unknown. Methods: We queried the STS-INTERMACS registry from 2008-2018 for adults receiving a primary, continuous-flow LVAD and surviving to 3 months without ongoing RHF, defined as presence of a right ventricular assist device (RVAD) or inotropic support. We excluded patients with atypical LVAD cannulation, bridge-to-recovery strategy, ongoing renal replacement therapy, or missing BB status at 3 months. At 3 months post-implant, patients receiving BB were propensity-matched 1:1 to those not receiving BB using a nearest-neighbor method without replacement. The primary outcome was a composite of all-cause mortality or LRHF, including the need for RVAD, inotropic support, or hospitalization for RHF or fluid overload, and was compared between groups with the Kaplan-Meier method and log-rank testing. Results: Among 14,317 patients meeting inclusion criteria, 4,880 patients receiving BB at 3 months were matched with 4,880 not receiving BB. Baseline covariates were well-balanced (Figure, panel A) and 11.2% of patients experienced early RHF. Over 3-years of follow up, patients receiving BB had a lower incidence of the primary outcome hazard ratio (HR) 0.91 (95% CI: 0.85-0.97), p=0.007 (Figure, panel B). This difference was driven primarily by lower rates of hospitalization for RHF or fluid overload (HR 0.83, 95% CI: 0.72-0.95, p=0.008) and all-cause mortality (HR 0.91, 95% CI: 0.82-1.02, p=0.11) while rates of late RVAD or inotropic support were similar. Conclusions: In this retrospective, propensity-matched analysis, the use of beta blockers after LVAD implant was associated with a modest reduction in the composite of all-cause mortality and LRHF. These data suggest BB may mitigate LRHF and should be confirmed with prospective studies.
Abstract 11865: Statin Decreases Risk of Dementia in Patients With Osteoarthritis: A Population-Based Study Abstract
Authors: Chung Chun Man, Kai Hang Yiu, Qingwen Ren, Shuk Yin Yu, Pui Fai Wong
Journal: Circulation (2022)

Emerging evidence suggested osteoarthritis is associated with increasing risk of dementia possibly because of accumulative age-related comorbidity and physical inactivity. Our study investigated whether statin use could reduce risk of dementia in patients with osteoarthritis. Methods Using a territory-wide health care database, we identified all eligible patients with osteoarthritis ( n = 146 933) from 2000 to 2010. Inverse probability of treatment weighting was used to adjust age, sex, comorbidities and concurrent medications between statin nonusers (n = 102 100) and statin users (n = 44 833). The adjusted hazard ratio was calculated using competing risk regression with Cox proportional-hazard model. Results Among all eligible patients, the mean age was 68.3 ± 13.4 years. The median follow-up was 5.6 years (interquartile range: 1.4-10.2 years), and 8247 (5.61%) patients developed dementia. Statin user (vs statin nonuser) was associated with a lower risk of dementia incidence [multivariable adjusted subdistribution hazard ratio (SHR) = 0.76 ; 95% confidence interval (CI), 0.72-0.80]. Among the subtypes of dementia, statin user (vs statin nonuser) was associated with a lower risk of Alzheimer disease [multivariable adjusted SHR = 0.67 ; 95% CI, 0.60-0.74] as well as vascular dementia [multivariable adjusted SHR = 0.88 ; 95% CI, 0.78-0.99]. This observation remains consistent in patients across all time-weighted LDL levels. Conclusions Our study suggested that statin use is associated with a lower risk of dementia in osteoarthritis patients, irrespective of time-weighted LDL level. In particular, statin user has a lower risk of Alzheimer disease and vascular dementia when compared with statin nonuser.
Abstract 12286: A Novel Yap Inhibitor Cbl0137 Protects Against Endothelial Inflammation and Atherosclerosis
Authors: Huanyu Ding, Minchun Jiang, Li Wang, Yu Huang
Journal: Circulation (2022)

Background: Endothelial activation is a critical hallmark in the initiation of atherosclerosis. Our previous study found that YAP activation plays a significant role in induction of endothelial inflammation and formation of atherosclerotic plaques, suggesting that targeting YAP signaling pathway might be effective for the treatment of atherosclerotic cardiovascular disease. We have recently set up a reporter gene assay-based drug screening platform and identified CBL0137 as an inhibitor of YAP activity in human endothelial cells. Methods: We used 8*GTIIC luciferase reporter gene assay to screen a drug library and other small molecule compounds. We validated the inhibitory effect of CBL0137 on YAP activity by detecting the expression of YAP target genes and phosphorylation of YAP, which were measured by quantitative real-time polymerase chain reaction and western blotting, respectively. Subsequently, we treated human endothelial cells with CBL0137 (1 μM) for 4 hrs, and then isolated the total RNA and performed transcriptome sequencing. We explored the anti-inflammatory effects and underlying mechanisms of CBL0137 in primary endothelial cells. Moreover, we assessed whether CBL0137 could retard formation of atherosclerotic plaques in ApoE-/- mice using carotid artery partial ligation-induced and chronic western diet-induced atherosclerosis models. Results: We identified CBL0137 as a novel YAP inhibitor through screening the drug library. In human endothelial cells, CBL0137 inhibited the phosphorylation of YAP at Y357 to suppress YAP activity, and therefore repressed the expression of YAP target genes. In addition, CBL0137 restrained endothelial inflammatory response in a YAP-dependent manner. Furthermore, CBL0137 inhibited YAP phosphorylation at Y357 via the tyrosine-protein kinase Src. In animal experiments, administration of low doses of CBL0137 attenuated endothelial inflammation and atherosclerosis induced by disturbed flow or atherogenic diets in both male and female ApoE-/- mice. Conclusions: CBL0137 is a novel YAP inhibitor that protects against endothelial inflammation and atherogenesis. CBL0137 might be a promising anti-atherosclerosis drug, but further investigations including clinical trials are required.
Abstract 11499: Management of Mixed Aortic Valve Disease Patients: Can N-terminal Pro-Brain Natriuretic Peptide Ratio Improve Risk Assessment?
Authors: Jeremy Bernard, Guillaume Jean, David Bienjonetti-Boudreau, Frederic Jacques, Lionel Tastet, Erwan Salaun, Marie-Annick Clavel
Journal: Circulation (2022)

Introduction: Risk assessment of mixed aortic valve disease (MAVD: concomitant aortic stenosis [AS] and regurgitation [AR]) patients is challenging, especially in non-severe lesions. In fact, these patients often present LV dysfunction after aortic valve replacement (AVR), and concomitant non-severe lesions appear to have similar outcomes than severe AS. Objective: We aimed to evaluate the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) ratio in risk stratification of MAVD patients. Methods: A total of 582 consecutive MAVD patients (mean age 73±11 years, 63% men) with at least concomitant mild AS and AR in whom a measurement of NT-proBNP during the same episode of care was available were included. NT-proBNP ratio (i.e., plasma level divided by maximal normal values for age and sex derived from Mayo Clinic laboratory) was calculated. In subgroups analyses, patients were divided according to MAVD pattern (severe AS or AR [n=364] and non-severe AS/AR [n=218]) and according to treatment strategy (early AVR [i.e., ≤3 months, n=429] or initial medical treatment [MT; n=153]). Results: Baseline median NT-proBNP ratio was 3.5 (IQR: 1.2-10.0). A total of 105 patients died during a median follow-up of 5.6 (2.8-6.1) years. Overall, NT-proBNP ratio ≥3 was significantly associated with long-term all-cause mortality in multivariable analyses adjusted for clinical and echocardiographic parameters as well as AVR as a time-dependent variable . NT-proBNP-ratio also showed incremental prognostic value at 1, 2 and 5 years over EuroSCORE II and echocardiographic parameters (all, net reclassification index &gt;0.45; p≤0.005). In all subgroups, NT-proBNP-ratio ≥3 remained independently associated with excess mortality ( severe AS or AR - HR[95CI]: 3.30[1.54-7.05], non-severe AS/AR : 2.14[1.03-4.43], early AVR : 2.48[1.16-5.39], initial MT : 2.72[1.02-7.22]; all p≤0.04). In patients who underwent early AVR, NT-proBNP-ratio ≥3 was also associated with higher 30-days mortality (9[4%] vs. 1[0.5%], p=0.02). Conclusions: In this series of MAVD patients, NT-proBNP-ratio was a powerful predictor of mortality, even in non-severe lesions, early AVR and medically treated patients. AVR may be reasonable before reaching an NT-proBNP-ratio ≥3.
Abstract 11243: A Quality Improvement Project to Optimize the Use of Guideline Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction in the Primary Care Setting
Authors: Arinze Bosah, Mian Tanveer Ud Din, Mrudula Gadani, Craig Alpert, Kevin Taffe
Journal: Circulation (2022)

INTRODUCTION The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure provided clear support for the clinical use of ARNIs, ACEIs or ARBs in addition to evidence-based Beta Blockers (BB) and Aldosterone Antagonists (AA) in HFrEF, also known as Guideline-Directed Medical Therapy (GDMT). Despite the known benefits of GDMT, there still remains a significant gap in the use of GDMT in the ambulatory setting. We present a resident-driven quality improvement project to increase the percentage of patients that are on GDMT at target doses. METHODS We performed a root cause analysis and identified the potential barriers to optimal GDMT in HFrEF patients by use of an anonymous survey completed by clinic residents and attending physicians. We then sequentially introduced QI interventions to optimize GDMT, including provider education, clinical pharmacy referral, and involvement of registered nurses and health coaches to identify HFrEF patients for our patient care huddles. GDMT data was collected on October 1 st , 2021 (baseline) and every 5 weeks until April 4 th , 2022 (intervention data). RESULTS Between October 1, 2021 and April 4, 2022, an average of 86 patients with HFrEF were analyzed from the resident clinic every month. Over the study period, the percentage of patients on any dose of GDMT increased from 73.3 to 77.8% (ARNI/ACEI/ARB); 84.1% to 88.2% (BB); and 45.5% to 50% (AA). The percentage of patients on target doses of GDMT increased from 21.7% to 25.9% (ARNI/ACEI/ARB); 8.7% to 16.2% (BB); and 34.8% to 42.4% (AA). The use of hydralazine/isosorbide in patients not on ARNI/ACEI/ARB improved from 12.5% to 24%. CONCLUSIONS A multi-disciplinary team approach shows a positive correlation in improving utilization of target doses of GDMT for HFrEF in the primary care setting. Significant gaps still remain in the utilization of GDMT, and further research is needed to identify targeted approaches to optimize outpatient medical therapy in the primary care setting.
Abstract 11849: The Influence of Atrial Fibrillation on Mortality Among Cancer Patients
Authors: Tomohiro Fujisaki, Daisuke Sueta, Eiichiro Yamamoto, Kenichi Tsujita
Journal: Circulation (2022)

Background: Although atrial fibrillation (AF) is associated with an increased risk of mortality in the general population, it is less studied in cancer patients. Methods: Using an observational registry in Japan, adult patients diagnosed with cancer at the Kumamoto University Hospital between 2007 and 2018 were identified. The trend in the prevalence of AF and their effects on all-cause mortality were investigated. Results: As many as 30,706 cancer patients were identified, and 19,496 patients were included after excluding patients with significant missing values. The overall median follow-up time was 4.5 years. The prevalence of AF was steady during the study period (n=250, 1.3%), and anticoagulation drugs were used in approximately 90% of patients with CHADS 2 scores ≥ 1. The Kaplan-Meier analysis revealed that AF patients had a lower survival estimate compared with non-AF patients (adjusted HR, 1.23; 95% CI, 1.01-1.49) (Figure 1). Subgroup analyses indicated that AF patients treated with warfarin or without any anticoagulation drugs were associated with poor prognosis (adjusted HR, 1.30; 95% CI, 1.05-1.61, adjusted HR, 1.91; 95% CI, 1.06-3.46, respectively), however, AF patients treated with direct oral anticoagulants were not associated with it (adjusted HR, 0.65; 95% CI, 0.36-1.17) compared with non-AF patients. Conclusions: Approximately 1.3% of cancer patients had AF, and the majority received anticoagulation treatments. AF seemed to be associated with poor prognosis among cancer patients, and the extent of association varied across anticoagulation strategies. Further studies are warranted to investigate the influence of AF and its anticoagulation strategies on cancer patients.
Abstract 12063: Antidepressant Use and Incident Ischemic Heart Disease in Women Veterans With Posttraumatic Stress Disorder
Authors: Ramin Ebrahimi, Carlos Alvarez, paul dennis, Laurie Shroyer, Hui Yang, Aaron Perkins, jean beckham, Jennifer Sumner
Journal: Circulation (2022)

Introduction: Antidepressants, namely selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are efficacious in reducing posttraumatic stress disorder (PTSD) symptoms, but their implications for cardiovascular health are unclear. Although SSRI/SNRI treatment could improve PTSD—thus decreasing cardiovascular risk, antidepressant use has also predicted cardiovascular events. This study examined if antidepressant use was associated with developing ischemic heart disease (IHD) in women veterans with PTSD. Methods: The Veterans Affairs (VA) electronic health record (EHR) database was used to identify women veterans with PTSD who engaged with VA healthcare from 2000-2019. Antidepressant use (documented in the EHR) was categorized as SSRIs, SNRIs, both SSRIs/SNRIs, other, or none (ref). We used Cox regression with time-varying exposure and covariates to estimate effects of antidepressants on risk of incident IHD (angina, MI, CAD). Once a woman was exposed to antidepressants, she was considered exposed until IHD onset or censoring. Age, race, ethnicity, and a range of time-varying risk factors [traditional risk factors (e.g., hypertension), other medical risk factors (e.g., obesity), women-specific risk factors (e.g., preeclampsia), psychiatric risk factors (e.g., depression)], were covariates. Results: The analytic sample comprised 143,324 women without IHD at start of follow-up; mean age was 36.1 years ( SD =11.0). Over a median follow-up of 8.6 years, there were 6,633 incident IHD cases. When adjusting for demographics and traditional IHD risk factors, exposure to SNRIs was associated with a 33% greater rate of IHD (95% CI: 1.24-1.43), SSRIs with a 27% greater rate (95% CI: 1.20-1.34), both SSRIs/SNRIs with a 59% greater rate (95% CI: 1.01-2.49), and other antidepressants with a 24% greater rate (95% CI: 1.17-1.31). Associations with SNRIs (HR=1.21, 95% CI: 1.12-1.30), SSRIs (HR=1.15, 95% CI: 1.09-1.22), and other antidepressants (HR=1.19, 95% CI: 1.13-1.26) remained significant in fully adjusted models. Conclusions: Antidepressant use in women veterans with PTSD may exacerbate risk of IHD. Mechanism-focused research and further work in women veterans without PTSD is also needed.
Abstract 12381: Elevated Serum Carboxy-Terminal Telopeptide of Type I Collagen is Associated With Clinical Outcomes in Patients With Stable Angina Pectoris Undergoing Percutaneous Coronary Intervention
Authors: sato junya, yoichiro Otaki, Tetsu Watanabe, Shingo Tachibana, Yuta Kobayashi, Tomonori Aono, Yuji Saito, Jun Goto, Taku Toshima, Tetsuya Takahashi, Naoaki Hashimoto, Masahiro Wanezaki, daisuke kutsuzawa, Shigehiko Kato, Harutoshi Tamura, Satoshi Nishiyama, Hiroki Takahashi, Takanori Arimoto, Masafumi Watanabe
Journal: Circulation (2022)

Background: Despite high risk of developing cardiovascular events, it was reported to be difficult to predict clinical outcomes in patients with stable angina pectoris (AP). Serum carboxy-terminal telopeptide of type I collagen (I-CTP), a marker of collagen degradation, was reportedly associated with clinical outcomes in patients with acute coronary syndrome. However, clinical usefulness of I-CTP has not yet been elucidated in patients with stable AP. The aim of this study was to examine whether I-CTP can predict clinical outcomes in patients with stable AP. Methods and Results: Serum I-CTP levels were measured in consecutive 360 patients with stable AP undergoing percutaneous coronary intervention. All patients were divided into three groups according to serum I-CTP tertiles: low I-CTP group (≤4.4 ng/ml, n=120), middle I-CTP group (4.5-6.2 ng/ml, n=118), and high I-CTP group (≥6.3 ng/ml, n=122). The high I-CTP group was older and showed higher levels of brain natriuretic peptide (BNP) and lower levels of estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF) compared with other groups. During the median follow up period of 1,347 days, there were 68 cardiovascular events including all-cause deaths. Kaplan-Meier analysis showed that the high I-CTP group had the greatest risk for cardiovascular events among 3 groups. Univariate Cox proportional hazard regression analysis showed that age, multivessel disease, BNP, eGFR, LVEF, and I-CTP were significantly associated with cardiovascular events. Multivariate Cox proportional hazard analysis demonstrated that I-CTP was an independent predictor for cardiac events after adjusting for confounding risk factors. Conclusion: I-CTP could be the feasible marker for predicting cardiovascular events in patients with stable AP.